高频电刀预防残端痛性神经瘤的实验研究

发布时间：2018-05-07 00:19

本文选题：残端痛 + 神经瘤　；参考：《苏州大学》2014年硕士论文

【摘要】：目的：探讨高频电刀电切和/或电凝处理周围神经断端预防残端痛性神经瘤形成的可行性和优越性。方法：三月龄Sprague-Dawley大鼠56只，随机分成4组，每组14只。四组大鼠的坐骨神经分别接受以下四种手术方式处理。刀切组：锋利手术刀片切除坐骨神经约0.5cm；电切组：高频电刀电切模式切除坐骨神经约0.5cm；电切+电凝组：高频电刀电切模式切除坐骨神经约0.5cm，然后电凝模式处理神经近断端；刀切+电凝组：锋利手术刀片切除坐骨神经约0.5cm，然后采用电凝模式处理神经近断端。术后定期观察并评价各组大鼠失神经肢体自噬情况、神经残端直径，采用HE染色方法观察神经残端纤维再生情况，并且通过免疫组化的方法观察神经生长因子(NGF)在坐骨神经残端的表达情况。结果： 1.术后各组大鼠均未出现死亡，坐骨神经切断后下肢均瘫痪，随时间延长自噬现象加重，部分患足出现溃疡。 2．四组中刀切+电凝组大鼠自噬行为评分最低、开始时间晚、重度自噬发生率最低；电切组自噬评分最高，开始时间早，且重度自噬发生率最高；其余两组居中。差异有统计学意义（P0.05）。 3.四组中刀切+电凝组神经残端膨大不明显，与周围组织粘连轻；电切组膨大最明显，且与周围组织粘连严重；其余两组居中。差异有统计学意义（P0.05）。 4. HE染色光学显微镜下可见：刀切+电凝组神经纤维排列相对整齐、规则，结缔组织增生不明显。其他三组神经纤维密集杂乱生长，结缔组织增生明显，其中电切组最差。 5.免疫组化结果显示：术后四组大鼠神经残端中均有NGF表达，且随着时间推移，NGF表达均逐渐减弱。术后3个时间点刀切+电凝组的NGF表达均低于其他三组,电切组均高于其他三组。差异有统计学意义（P0.05）。结论：本实验证明，，与刀切组、电切组、电切+电凝组相比，采用刀切+电凝法处理神经残端，可以有效抑制残端痛性神经瘤形成。本方法操作简单，避免了复杂的手术过程和高昂的手术费用。
[Abstract]:Purpose :

To investigate the feasibility and superiority of high - frequency electrotome and / or coagulation treatment on the formation of stump pain neuroma .

Method :

In March - old Sprague - Dawley rats , 56 rats were randomly divided into 4 groups .
Electrical cutting group : high - frequency electrotome resection mode to remove the sciatic nerve about 0.5cm ;
Electrical cutting + coagulation group : The sciatic nerve was cut away by high frequency electrotome about 0.5cm , then the nerve proximal end was treated by coagulation mode ;
Knife - cut + electric coagulation group : A sharp surgical blade was used to cut the sciatic nerve about 0.5cm , then the nerve proximal end was treated with the coagulation mode . After operation , the self - tophagocytosis and the diameter of nerve stump were observed and evaluated . The nerve stump fiber regeneration was observed by HE staining method , and the expression of nerve growth factor ( NGF ) in the stump of sciatic nerve was observed by immunohistochemistry .

Results :

1 . No death occurred in the rats after operation , the lower limbs were paralyzed after sciatic nerve transection , the autophagy phenomenon increased with time , and some ulcers occurred in some parts .

2 . The self - tophagy behavior was the lowest in the four groups , and the incidence of severe autophagy was the lowest in the four groups .
The autophagy score was the highest , the start time was early , and the incidence of severe autophagy was the highest .
There was significant difference between the two groups ( P0.05 ) .

3 . The nerve stump of the knife - cut + electric coagulation group in the four groups was not obvious , which was less than that of the surrounding tissue ;
The electric resection group was the most obvious and had serious adhesion to the surrounding tissue ;
There was significant difference between the two groups ( P0.05 ) .

4 . Under the microscope of HE staining , the arrangement of nerve fibers in the knife - cut + electric coagulation group was relatively regular , the rules and connective tissue hyperplasia were not obvious . The other three groups of nerve fibers were dense and disordered , the connective tissue proliferation was obvious , among which the electric resection group was the worst .

5 . The expression of NGF in the nerve stump of the four groups was significantly decreased with time , and the expression of NGF in the three groups was lower than that of the other three groups ( P0.05 ) .

Conclusion :

Compared with the knife - cut group , the electric - cut group and the electro - coagulation group , the present experiment proves that the method can effectively inhibit the formation of the stump pain neuroma compared with the knife - cut group , the electric - cut group and the electric - cut + electric coagulation group , and the method has the advantages of simple operation , avoids complicated surgical procedures and high surgical cost .

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.4

【参考文献】